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This one is about: Awareness Under Anesthesia by Amy Beth Hilton, MD
(c) 1996 Wide Smiles
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Thu, 23 Jan 1997
This question has come up before on the list. Joanne is correct that this is a rare occurrence, and that when it happens, the person is almost always pain-free, just aware of voices around them. What is sometimes disturbing to people about this experience is being unable to move. This can occur whether or not the anesthesiologist uses medications which block nerve impulses to the muscles (called "muscle relaxants" or "paralytics" but I do not use the second term because of the emotional implications of being paralyzed, and because it is not the same as being paralyzed from a spinal cord injury or stroke--it has nothing to do with the spinal cord or brain and is very temporary, not permanent).
While this _could_ happen to anyone during any procedure, it is extremely rare in healthy adults or children having routine surgeries. People who are at risk include those too sick or unstable to tolerate much anesthetic (heart failure, massive blood loss after trauma, etc.), those who need much more anesthetic than would normally be used (heavy drinkers, drug abusers, and those who must use narcotics or tranquilizers on a regular basis for a medical condition -- it is vital to give the anesthesiologist an accurate account of the amount of alcohol you drink, packs of cigarettes you smoke, and amounts of narcotics, tranquilizers, or other mind-altering substances you use. The information will not be used to judge your character, merely to estimate your tolerance for anesthetics). Certain operations put patients at higher risk of awareness. Open heart procedures have a period of instability during and immediately after the cardiac bypass (while the machine is circulating the patient's blood and the heart is stopped). During Cesarian sections under general anesthesia, drug administration to the mother is minimized to reduce the sedating effect on the baby (most C-sections under general anesthesia are done for emergencies where the baby will be deprived of oxygen and blood supply unless gotten out as fast as humanly possible, so the baby is already compromised). The anesthesiologist aims for a dose which will be adequate for the mother to be asleep, but no more than is needed. For some small percentage of people, this will be an underestimate and they may be aware. In these situations, there may be some pain, as narcotics pass quickly into the baby's system and depress breathing, so most anesthesiologists avoid giving the mom narcotics until the baby is out. Once the baby is separated from the mother's blood supply, the anesthesia is increased to provide an added margin of safety re: awareness. This sort of C-section is done for conditions which threaten the life of the baby, the mother, or both, so the risk of awareness must be weighed against the risk to the baby and the mother (who may be unstable from blood loss or other problems) of giving more anesthetic.
Whether people can retain a subconscious memory of things they might have heard, felt, or seen during an anesthetic is much debated by anesthesiologists. There are studies which have shown people can be influenced by verbal stimuli during anesthesia (eg. more apt to pick a word out of a group of words if it was spoken in their ear while they were anesthetized), but there are about an equal number of studies that find no effect. There are many other traumatic events which occur to a child before and after the actual surgery which I would easily believe could cause a sort of "post-traumatic stress disorder" in a susceptible child. Other than providing a generally secure and supportive environment, minimizing pain, and avoiding the need for physical restraint by either verbally or pharmacologically enlisting the child's cooperation, I don't see any way to avoid the fact that some surgical experiences will be traumatic. It is a sad fact of life for our children which can be turned into a strength by teaching them how to cope with adversity.
Amy Beth Hilton, MD
Anesthesia Consultant to Wide Smiles
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